WHEC Update - August 2007

Publications are like people, in that, some have high impact and some are not. When someone requests us to publish his or her work in WomensHealthSection.com and / or WHEC Update, we try to make the experience a happy one. We do not intrude or change more than absolutely necessary. Words we dislike to hear from the writers / editors around the world: "I want to publish my work in WomensHealthSection.com but I do not know anyone there". It is time to repeat the following: You do not have to know anyone at Women's Health and Education Center (WHEC) to have your work seen by us. We see and read everything. If there is a reason to believe a work or research is right for WomensHealthSection.com or WHEC Update, I will personally see the work and accommodate reasonable requests. We do not change the message. We report. We love publishing ground-breaking medical research in women's health and healthcare, and we hope you love it too. I look forward to discovering what I can do to help our fragile planet. It is urgent and vital that we consider public space to be a public good. You do not have to be a politician or a billionaire to help a fellow citizen. In the end, simple acts of humanity and justice can change the world. Leadership is not a mysterious art practiced by only a select few - it is the daily response of every man and woman who wishes to make a positive difference in the world and make it a little bit better place as a result of their efforts. Let us start from what they know, and build on what they have.

Currently there is a worldwide effort to reduce maternal mortality in line with the Millennium Development Goals (MDGs) to reduce maternal mortality by 75% by 2015. In countries where the prevalence of obstetric fistulae is high, all curricula for trainee midwives, nurses, and physicians should include not only theoretical training on obstetric fistula prevention but also treatment. Epidemiologic research is urgently needed to identify communities with a high prevalence of fistulas and to determine the characteristics of women at high risk for bladder or urethral injury during childbirth. Our publications draw attention to the urgent issue of obstetric fistulae in the developing world and advocate for change. They provide essential, factual back-ground information along with guiding principles for clinical management and program development. We hope to contribute to the development of more effective services for women under treatment for fistula repair. We hope to motivate future research that will further enhance the understanding of reproductive health. We will only be able to attain the MDGs and reduce crushing poverty that is debilitating the lives of billions of people across this planet if we pool our resources and efforts for the common good of humanity. A global partnership for development must ensure win-win conditions for the rich and the poor alike.

The Capacity to Care
Rita Luthra, MD

Your Questions, Our Reply:

What are your views on gender testing and gender selection? How is WHEC addressing this issue in China, India and other developing countries where boy children are preferred?

Sex Selection: The low value given to women and girls in some countries is reflected in a marked preference for boy children. The practice of female infanticide has also been documented in some places. Over the decades, this has translated into many practices that heavily discriminate against girls, such as neglect in feeding, education and health care. Over the last decade, the ratio of girls to boys in the 0 - 6 year age group has become increasingly skewed in a number of countries. For instance, India's census revealed that the juvenile (0 - 6 years) sex ratio declined from 945 girls per 1,000 boys in 1991 to 927 in 2001, with some of the steepest declines occurring among the better educated and in economically better-off districts that also have greater access to commercial health services. Rapidly declining fertility and the trend to limit families to one or two children has increased desire of couples to have a boy. National records on sex ratio at birth in China and South Korea have shown similar rapid changes that are unlikely to be sustainable in the long term.

The emergence and increased availability of ultrasound equipment, which can detect the sex of fetus early in pregnancy, has opened up the opportunity for the commercial use of medical technology to pre-select and terminate pregnancies of female fetuses, thus reinforcing the devaluation of girls and women. This is a conundrum which cannot be resolved by focusing only on medical technology. The most severely affected countries such as China, India and South Korea have all banned prenatal sex determination through use of ultrasound or pre-conception techniques. Such policies have so far been largely ineffective because demand continues to be high.

Women's Health and Education Center (WHEC) with various NGOs and civil society organizations are currently involved in large-scale awareness and sensitization campaigns and in organizing a broader social debate on the devaluation of females and the consequences of sex preference. Join us in our mission.

About NGO Association with the UN:

Chairpersons of UN Committees and their views on various issues:

Tiina Intelmann, the Permanent Representative of Estonia to the United Nations, was elected Chair of the Second Committee (Economic and Financial) for the sixty-first session of the General Assembly on 8 June 2006. Her views on some of the issues on the agenda of Second Committee:

In terms of trade and development, where do you think the United Nations has been most effective and where does it have the greatest potential to obtain results?
The issue of trade is very complicated, especially since the suspension of the World Trade Organization's (WTO) Doha round [these negotiations, aimed at increasing economic growth by lowering trade barriers worldwide, reportedly broke down because developed countries could not agree on dismantling their agricultural subsidies]. There have even been discussions as to whether we should still try to work things out and improve multilateral mechanisms, or aim at regional mechanisms, or just go bilateral. It is still clear that WTO is the central pillar of the international trading system and that a well-functioning international trading system would greatly contribute to achieving the Millennium Development Goals. I think it is not only the faith and understanding of Burkina Faso that we should have a multilateral framework, but I think it is the understanding of all of us, and we are trying to work towards it. Of course, it is very difficult. Trade liberalization is a very difficult issue and it is not only a North-South issue, it is also a South-South issue.

How were higher oil prices worldwide reflected in the Second Committee and what were some of the energy issues discussed?
Energy has become a very important topic. Oil prices are fluctuating; they were at a very high point during summer and now they have gone down a little bit. Oil prices go up and down, but we should also find a way to use other energy sources. We had a panel discussion on energy security where experts talked about solar energy and other alternative energy sources. This is a concern that we all have, because we cannot rely only on oil, and as we proceed I think more and more countries will pay attention to this fact. It also relates to climate change. A recent report published in Great Britain showed that climate change is not only about the air we breathe and the melting glaciers in faraway places. Climate change has very serious economic and financial implications. The report said that if we don't address this issue now we are going to face tremendous costs in the future.

United Nations Secretary-General Ban Ki-moon Message on the International Day of the World's Indigenous People — 9 August 2007:

By resolution 49/214 of 23 December 1994, the UN General Assembly decided to observe 9 August as the International Day of the World's Indigenous People every year during the First International Decade of the World's Indigenous People (1994 -2004). In 2004, by resolution 59/174 of 20 December 2004, the Assembly proclaimed the Second International Decade of the World's Indigenous People (2005 - 2014) and decided to continue observing the Day every year during the Second Decade. This year's observance will be devoted to honoring indigenous youth, languages and sacred sites. The United Nations commemoration in New York is organized by the Secretariat of the Permanent Forum on Indigenous Issues and the NGO Committee on the Decade of the World's Indigenous People.

"Recently, the international community has grown increasingly aware of the need to support indigenous people -- by establishing and promoting international standards; vigilantly upholding respect for their human rights; integrating the international development agenda, including the Millennium Development Goals, in policies, programs and country-level projects; and reinforcing indigenous peoples' special stewardship on issues related to the environment and climate change. Our fast-paced world requires us to act with urgency in addressing these issues. As we do, let us be guided by the fundamental principle of indigenous peoples' full and effective participation. Let us give life to "Partnership in action and dignity" -- the theme given by the General Assembly to this Second International Decade of the World's Indigenous People. On this International Day, let this be our motto and inspiration."

Collaboration with World Health Organization (WHO):

An examination of the nexus of security, insecurity and health shows that security is a prerequisite for health. The many and varied ways that armed violence - including threats of armed violence - can affect people's health and can be documented by formal studies; however, valuable data also exist in other reports, such as media reports. The health community needs to recognize that people's insecurity is a massive global health issue. The foreign policies of donor governments should incorporate recognition that documentation, analysis and publication of data describing the impact of insecurity on people's health can lead to the creation of policies to enhance people's security. In contexts of poor security, public health interventions and the delivery of health care to the individual are more difficult to perform and less likely to succeed than in contexts of security. Violence - including the threat of violence - in such contexts results in injury, death, psychological harm, impaired development or deprivation. The primary purpose of the United Nations is to hold responsibility for a third level of security: international or global peace and security. Human Development Report 2005, Details: http://hdr.undp.org/reports/global/2005/pdf/hdr05_summary.pdf (pdf)

Bulletin of the World Health Organization; Volume 85, Number 8, August 2007, 569-648 Table of contents

Collaboration with UN University (UNU):

Researching Conflict in Africa: Insights and Experiences. Parts of Africa experience violence and seemingly intractable conflicts. These violent conflicts have drawn researchers seeking to determine and explain why conflicts have drawn researchers seeking to determine and explain why conflicts are prevalent, what makes them intensify, and how conflicts can be resolved. This book examines the ethical and practical issues of researching within violent and divided societies. It provides fascinating and factual case studies from Angola, the Democratic Republic of Congo, Ghana, Nigeria, Rwanda and South Africa. The authors provide insights about researching conflict in Africa that can only be gained through fieldwork experience. Publishing Agency: United Nations University (UNU). (http://www.oecd.org/dev/aeo)

Point of View:

Worldwide, pre-eclampsia ('toxemia of pregnancy') is a common cause for women to die during or shortly after pregnancy; at least one woman dies from pre-eclampsia every seven minutes. It is also the most common reason for babies who are otherwise doing well to be delivered prematurely to protect maternal health and safety. In many ways pre-eclampsia is similar to the systemic inflammatory response syndrome ('sepsis'). Hitherto, the management of pre-eclampsia was guided by expert opinions not based on firm evidence. Therefore, the requirement is a clinical prediction model that accurately identifies a women's risk for adverse outcomes, thereby reducing the risk for women while safely prolonging pregnancies remote from term (to improve fetal outcomes). This project is part of an integrated strategy to better understand and modify the mechanisms of disease in pre-eclampsia.

We have surveyed Canadian practice, undertaken feasibility and pilot studies for this project, and, in the first 3 years of this project, developed an outcome prediction model that effectively identifies those women at risk for adverse outcomes. In so doing, we have found that instituting assessment and surveillance guidelines is associated with improved maternal outcomes in women with pre-eclampsia (Obstet Gynecol 2007). We have determined that many of the current criteria for 'severe' disease do not identify women at greatest risk (Hypertens Pregnancy [in press]). To validate the PIERS model we will recruit women in Canada, the UK, New Zealand, and Australia who are admitted to a hospital (i) pre-eclampsia or (ii) other forms of pregnancy hypertension. We will also validate the model in general obstetric, rather than high risk, units. A further 'mini-PIERS model' has also been developed, and will be validated in Developing World settings (Uganda, South Africa, and Fiji) and will be used to identify those women who require transfer to higher level maternity care. Mini-PIERS has the support of the UNDP / UNFPA / WHO / World Bank Special Programme of Research, Development & Research Training in Human Reproduction. Both the full PIERS and mini-PIERS models will be used clinically (to guide management) and in research (in both clinical trials and basic science research), and will provide an evidence base on which to build future practice, improving outcomes for pregnant women and their babies.

By Dr. Peter von Dadelszen
Department of Obstetrics and Gynecology
University of British Columbia
Vancouver, Canada

Joint United Nations Program on HIV/AIDS (UNAIDS):

By 2005, ensure development and accelerated implementation of national strategies for women's empowerment, promotion and protection of women's full enjoyment of all human rights and reduction of their vulnerability to HIV/AIDS through the elimination of all forms of discrimination, as well as all forms of violence against women and girls, including harmful traditional and customary practices, abuse, rape and other forms of sexual violence, battering and trafficking in women and girls;

Reducing vulnerability

The vulnerable must be given priority in the response
Empowering women is essential for reducing vulnerability

By 2003, in order to complement prevention programs that address activities which place individuals at risk of HIV infection, such as risky and unsafe sexual behavior and injecting drug use, have in place in all countries strategies, policies and programs that identify and begin to address those factors that make individuals particularly vulnerable to HIV infection, including underdevelopment, economic insecurity, poverty, lack of empowerment of women, lack of education, social exclusion, illiteracy, discrimination, lack of information and/or commodities for self-protection, all types of sexual exploitation of women, girls and boys, including for commercial reasons; such strategies, policies and programs should address the gender dimension of the epidemic, specify the action that will be taken to address vulnerability and set targets for achievement;

By 2003, develop and/or strengthen strategies, policies and programs, which recognize the importance of the family in reducing vulnerability, inter alia, in educating and guiding children and take account of cultural, religious and ethical factors, to reduce the vulnerability of children and young people by: ensuring access of both girls and boys to primary and secondary education, including on HIV/AIDS in curricula for adolescents; ensuring safe and secure environments, especially for young girls; expanding good quality youth-friendly information and sexual health education and counseling service; strengthening reproductive and sexual health programs; and involving families and young people in planning, implementing and evaluating HIV/AIDS prevention and care programs, to the extent possible;

By 2003, develop and/or strengthen national strategies, policies and programs, supported by regional and international initiatives, as appropriate, through a participatory approach, to promote and protect the health of those identifiable groups which currently have high or increasing rates of HIV infection or which public health information indicates are at greatest risk of and most vulnerable to new infection as indicated by such factors as the local history of the epidemic, poverty, sexual practices, drug using behavior, livelihood, institutional location, disrupted social structures and population movements forced or otherwise;

Children orphaned and made vulnerable by HIV/AIDS

Children orphaned and affected by HIV/AIDS need special assistance

By 2003, develop and by 2005 implement national policies and strategies to: build and strengthen governmental, family and community capacities to provide a supportive environment for orphans and girls and boys infected and affected by HIV/AIDS including by providing appropriate counseling and psycho-social support; ensuring their enrolment in school and access to shelter, good nutrition, health and social services on an equal basis with other children; to protect orphans and vulnerable children from all forms of abuse, violence, exploitation, discrimination, trafficking and loss of inheritance;

Ensure non-discrimination and full and equal enjoyment of all human rights through the promotion of an active and visible policy of de-stigmatization of children orphaned and made vulnerable by HIV/AIDS;

Urge the international community, particularly donor countries, civil society, as well as the private sector to complement effectively national programs to support programs for children orphaned or made vulnerable by HIV/AIDS in affected regions, in countries at high risk and to direct special assistance to sub-Saharan Africa;

Alleviating social and economic impact

To address HIV/AIDS is to invest in sustainable development

By 2003, evaluate the economic and social impact of the HIV/AIDS epidemic and develop multisectoral strategies to: address the impact at the individual, family, community and national levels; develop and accelerate the implementation of national poverty eradication strategies to address the impact of HIV/AIDS on household income, livelihoods, and access to basic social services, with special focus on individuals, families and communities severely affected by the epidemic; review the social and economic impact of HIV/AIDS at all levels of society especially on women and the elderly, particularly in their role as caregivers and in families affected by HIV/AIDS and address their special needs; adjust and adapt economic and social development policies, including social protection policies, to address the impact of HIV/AIDS on economic growth, provision of essential economic services, labor productivity, government revenues, and deficit-creating pressures on public resources;

By 2003, develop a national legal and policy framework that protects in the workplace the rights and dignity of persons living with and affected by HIV/AIDS and those at the greatest risk of HIV/AIDS in consultation with representatives of employers and workers, taking account of established international guidelines on HIV/AIDS in the workplace;

Research and development

With no cure for HIV/AIDS yet found, further research and development is crucial

Increase investment and accelerate research on the development of HIV vaccines, while building national research capacity especially in developing countries, and especially for viral strains prevalent in highly affected regions; in addition, support and encourage increased national and international investment in HIV/AIDS-related research and development including biomedical, operations, social, cultural and behavioral research and in traditional medicine to: improve prevention and therapeutic approaches; accelerate access to prevention, care and treatment and care technologies for HIV/AIDS (and its associated opportunistic infections and malignancies and sexually transmitted diseases), including female controlled methods, and in particular, appropriate, safe and affordable HIV vaccines and their delivery, and to diagnostics, tests, methods to prevent mother-to-child transmission; and improve our understanding of factors which influence the epidemic and actions which address it, inter alias, through increased funding and public/private partnerships; create a conducive environment for research and ensure that it is based on highest ethical standards;

News, Invitations and Letters:

THE SECRETARY-GENERAL MESSAGE ON WORLD POPULATION DAY -11 July 2007: The theme of this year's World Population Day - men as partners for maternal health - focuses attention on the fundamental role of men in supporting women's rights, including their right to sexual and reproductive health. Today, more than half a million women die each year during pregnancy and childbirth, 99 per cent of them in developing countries. Many more suffer serious complications that can have a severe impact on the quality of life for women and their families. Almost all of this death and suffering is preventable. As partners for maternal health, men can save lives. They play a decisive role in many respects. Husbands often make decisions about family planning and the use of household resources that influence the well-being and prospect of the whole family. The support of an informed husband improves pregnancy and childbirth outcomes and can mean the difference between life and death in cases of complications, when women need immediate medical care. And supportive fathers can play an important role in the love, care and nurturance of their children. Far too many women die during pregnancy and childbirth because their right to sexual and reproductive health is denied. The alarming spread of HIV among women is a tragic reminder that in many places, women do not have the power to protect their own health. When a woman can plan her family, she can plan the rest of her life. When she is healthy, she can be more productive. And when her reproductive rights are promoted and protected, she has freedom to participate fully and equally in society.

Several countries have succeeded in significantly reducing maternal death rates in the space of a decade, when women gained access to family planning, midwives and backup emergency obstetric care. However, much more needs to be done to achieve the Millennium Development Goal of improving maternal health around the world by 2015. Partnering with men is an important strategy for advancing reproductive health and rights. And gender equality, another Millennium Development Goal, is most likely to be achieved when men recognize that the lives of men and women are interdependent and that the empowerment of women benefits everyone. On this World Population Day, let us all encourage men to become partners and agents for change, supporting human rights and safe motherhood in every way possible, thus contributing to creating a world of greater health and opportunity for all.

Ethics in Action: The Ethical Challenge of International Human Rights Nongovernmental Organizations. Edited by Daniel A. Bell and Jean-Marc Coicaud, Reviewed by Mark Gibney. It would certainly appear that participants in these sessions upon which the book is based learned an enormous amount from the enterprise itself. But Ethics in Action should prove to be very useful to others as well. For one thing, the exercise of raising the most elementary question that all International Non Governmental Organizations (INGOs) should face-how and why do we do what we do?-is something that is seemingly not asked often enough. This might also lead to another seldom asked question, which relates to the proliferation of INGOs. Is this such a "good thing", or is proliferation an indication that more time, effort and money are spent on propping up one's organization, but at the expense of "others"? Details: http://www.un.org/Pubs/chronicle/2007/issue1/0107p46.htm

Special Thanks:

WHEC thanks Mr. David Lazarus, Chief, United Nations Information Services, UN ESCAP (United Nations Economic and Social Commission for Asia and the Pacific) for the priceless support. Thanks for the friendship.

Beyond the numbers...

Together we can build a poverty-free world. Poverty is not created by the impoverished - it has been created and sustained by the economic and social system that we have designed for ourselves, the institutions and concepts that make up that system - and the policies that we pursue.